NHS North Derbyshire CCG CCG Organisational Development

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1 CASE STUDY NHS North Derbyshire CCG CCG Organisational Development June 2014 Summary How do you effect real change in approaches to governance, leadership, team working, membership and stakeholder engagement? NHS North Derbyshire CCG used organisational development (OD) to focus on developing the organisation s culture and individuals leadership styles. Key Learning Points 1. OD activities are likely to have the greatest impact where they are experienced as practical and relevant, particularly by clinicians. In this instance the process of developing shared values and fostering a healthy organisational culture was a powerful way of building trust and positive working relationships and helping staff to work more effectively together. 2. As an experience, OD is best when it is done with and not done to. The time set aside for OD is viewed as useful time for reflection, and more than just learning and doing. 3. The OD plan must be treated as a live document and as a guide to action. Here OD goals and plans shifted in light of changes to internal and external circumstances. The focus on culture and leadership development has continued as the OD Plan is refreshed. 4. 1

2 CCG context NHS North Derbyshire CCG covers a mixture of urban and rural areas and has a population of 290,000. The CCG incorporates 38 GP practices in five geographical localities: Chesterfield, Dronfield, High Peak, North Dales and North East. North Derbyshire CCG has some pockets of deprivation with an Index of Multiple Deprivation (IMD) score of North Derbyshire s 2013/14 budget was 373m and has a running cost allowance of 7.11m. What is this case study about? What were the organisational development challenges? This case study describes how NHS North Derbyshire CCG used OD activities to focus on developing the organisation s culture and individuals leadership styles to effect real change in their approach to governance, leadership, team working and membership and stakeholder engagement. Prior to authorisation many staff transferred from the Primary Care Trust (PCT) to the CCG which operated in shadow form from 2011, with a number of responsibilities already devolved. Authorisation was described as a straightforward process, with all requirements coded green. Jackie Pendleton, the Chief Officer, noted that this meant that they had little initial steer about the content of their OD Plan, although they themselves were aware of the need to develop a new culture and style, to operate differently, to benefit from the clinical knowledge and multiprofessional perspective of their members, and to empower staff to work in new ways. The clinical reference group, comprising the five GPs on the governing body; the five locality leads; local authority representatives from public health and adult and children s services; and several providers is and has been an important forum in identifying OD needs before they come more formally to the governing body for sign off. What OD approaches were used? Developing the CCG s values The development of the CCG s values was seen as an important step in making a clear statement about the culture the CCG wanted to create and about how it was going to do business. The values were based on a desire to be a strong, resilient, high performing and sustainable organisation. The process began with a stakeholder event at which the CCG s statement of key values was initiated. Dr Ben Milton, the Clinical Chair, recalled how they were keen to involve GPs in the new draft constitution but in a way which was interesting and meaningful. One thing they did at that event was to invite people to write down words which were important to them. In the same period they held events with the public and Dr Milton set out Our commitment to you, because he felt it important for the organisation to make a clear statement about how it was going to operate. The values before then were clear to those of us involved in the leadership of the organisation, but [they] hadn t been clearly articulated in such a way. So we took the documentation from authorisation, and distilled out the key words, the key phrases, the 2

3 key sentiments in there, and over the course of a series of workshops, with some staff, with practice members, and with a few key stakeholders, started to distil down what was really key, and what made North Derbyshire CCG something different. Dr Ben Milton, Clinical Chair Further workshops distilled the 20 or so key words into the four value statements which convey the essence of the CCG patient focus, integrity, courage and responsiveness. Interestingly the discussions led them to adopt responsiveness ahead of accountability because it was felt to capture a sense of I m going to solve this, rather than whose job is it?. In a similar manner courage is about, for example, speaking up rather than deferring or ignoring an issue. The key words and values appear in a Word Cloud which is displayed on posters and screen-savers, and have been adopted by some member practices although there is no requirement for them to do so. Figure 1: NHS North Derbyshire CCG s values word cloud These values are now lived at all levels through appraisal processes, the recently introduced and very well received recognition awards to staff, in commissioning decisions, and in everyday conversations through providing key reference points for support and challenge. The recognition award, for example, is open to all practice staff as well as those in the CCG, and attracts positive local press coverage. But, in addition to these special events, Dr Milton observed that he finds himself mentioning the values every day in his CCG role. Developing the CCG s leadership Forty five managers, including seventeen practice managers, have taken part in a leadership development programme which is now being reviewed and evaluated. The programme was also open to GPs but so far none have taken part. The programme consisted of five modules covering, individual leadership, communication, the leader as coach, performance management, and 21 st century leadership. Each participant also had access to six coaching sessions and 360 degree feedback. A number of individuals referred specifically to the insights they gained from their introduction, during the programme, to the Insight Colour Profiling tool - a colour-based version of the Myers-Briggs Type Indicator tool. Those who took part in the programme described it as a very powerful experience. One practice manager who 3

4 took part said he found it very beneficial and practically focussed, knowing he s a doer rather than a theorist. He has changed the way he deals with some situations, leading to better, quicker results. Following the evaluation of the leadership development programme the CCG is planning to continue this strand of development through action learning sets. Developing the CCG s governance - Development work with the governing body takes place through alternate monthly meetings. These sessions include a consideration of patients stories (either directly or through clinical presentations); taking a closer look at aspects of the business including understanding the workings of internal Audit and the Board Assurance Framework; and exploration of the Insight Colour Profiling tool (discussed above) to further develop the sense of a common language. Currently the CCG is undertaking a review of its governance processes to make sure committee creep (greater bureaucracy) hasn t happened. As part of this process they are asking their member clinicians how do they feel engaged?, could it be better?, could we make better use of their time? In this vein they have already gained agreement that they need only hold 4 formal governing body meetings each year. In other months they intend to go out of the CCG offices to meet in, for example, a practice or in a care home, to respond to the GPs request for more informal thinking time. Developing the CCG s public and member engagement - Through its localities structure the CCG has worked to create a culture of engagement and build momentum for greater ownership of the CCG s agenda at practice level. Further to this, each locality holds a patient participation forum every quarter. There is a very real passion at the Board level at the CCG to actively promote engagement from its member practices. Nigel Atkin, Practice Manager Indeed, a number of the people said how much they welcomed the Chief Officer s weekly blog which is always appreciative and focuses on clinical issues as much as managerial ones. Both Dr Ben Milton (Clinical Chair) and Jackie Pendleton (Chief Officer) emphasised how much they value and seek to acknowledge the discretionary efforts that so many people make. What happened? What was the impact of the organisational development? With very clear and committed leadership from the Clinical Chair and Chief Officer the process of developing the CCG s values, which preceded and inform their strategy and plans, has had a number of positive ramifications. The process itself was very inclusive, with wide participation and a number of iterations before the final set of values patient focus, integrity, courage and responsiveness were established. The four key values and the word cloud are visible throughout their office and on all of the CCGs core documentation and policies. It is all over the organisation it s not just a document... it s something that everybody abides to and everybody works to, it s part of the organisation now. And we don t just make decisions in isolation - we make decisions based on the word cloud. Aaron Gillott, Head of Finance 4

5 I have been really delighted by the way that the GPs I work with have taken on board the values. Dr Stuart Saunders, Locality Lead One particularly telling example of the impact of the values comes from a locality manager who joined the CCG from her previous role in the local authority. Naomi Compton said she had never thought about an NHS role before but after attending a CCG-led event locally she was so impressed by the way that the values were being used that she decided to apply for the next suitable role that came up. Now she is able to report how the CCG values provide a clear and positive reference point as she works through difficult decisions with social care partners about what can be afforded and which services matter most to local people with long term conditions. A number of individuals referred specifically to the impact of the insights they gained from their introduction, during the leadership development programme, to the Insight Colour Profiling tool - a colour-based version of the Myers Briggs tool. There was a general feeling that the Insight Colour Profiling tool has been helpful in understanding different peoples approaches and perspectives, but also understanding how best to communicate with people. That helped me as an individual to understand how people react to different situations, and how I react to people, and how people react to me. And it helps you to understand how to develop different schemes within the organisation, and how best to pick up those schemes. Aaron Gillott, Head of Finance A number of GPs reported that through greater patient engagement and discussion at the patient participation forums they have learned about the importance of carers and voluntary organisations to an extent they hadn t fully appreciated before. As a result, a Directory of Voluntary Services is now being put together and a pilot of a single point of access to the voluntary sectors services is being started. Both the CCG s locality structure and the involvement of GPs in creating the values discussed above are said to foster a strong sense of member engagement. The ethos is one of supporting general practice there is a strong sense of partnership and good communications are essential to the style of the CCG. Dr Stuart Saunders, Locality Lead The Clinical Chair, Dr Ben Milton, talked about the cyclical process of OD being incorporated into everyday thinking, reflecting and planning and using day-to-day intuition to stay alert to areas for organisational development attention. 5

6 So in terms of assessing the impact and planning going forward, this is an iterative process, it s ongoing, and whilst I don t think we can lay claim to any particularly fantastic sense of a quantitative assessment of this, there is a constant qualitative assessment of reviewing our progress, and how we need to change as a result Dr Ben Milton, Clinical Chair What did the CCG learn from their OD experiences? OD activities are likely to have the greatest impact where they are practical and relevant. In this example, the process of developing shared values and fostering a healthy organisational culture was a useful way of building trust and positive working relationships and getting staff to work more effectively together. Always value and seek to acknowledge the discretionary efforts that so many people make. As an experience, OD is best when it is done with and not done to. The time for OD is viewed as useful time for reflection, and not just learning and doing. We re constantly reflecting, we re really lucky particularly with our governing body GPs, that actually they like to take the time, to think about how could that have been different? and could we have run that meeting differently? So I think through the development session we do a lot of self-reflection and evaluation about what do we need to do?, and how do we need to behave differently? Jackie Pendleton, Chief Officer The OD plan should be considered as live and refreshing it periodically is good practice. OD goals and plans constantly shifted in light of changes to internal and external circumstances. The focus on culture and leadership development has continued as the OD Plan is refreshed. I think it s a never ending task, and you need to constantly go back and reflect on where you are now and how the system around you has changed, and therefore what you need to do as a result of that. Jackie Pendleton, Chief Officer For further information please contact: Jackie Pendleton, Chief Officer, NHS North Derbyshire CCG. 6

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